Intended for healthcare professionals


Is it acceptable for people to be paid to adhere to medication? Yes

BMJ 2007; 335 doi: (Published 02 August 2007) Cite this as: BMJ 2007;335:232
  1. Tom Burns, chair of social psychiatry
  1. Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX
  1. tom.burns{at}

    Plans to give drug users shopping vouchers to attend treatment programmes and stay clean have been unveiled by NICE. Joanne Shaw believes that payment creates perverse incentives, whereas Tom Burns says rewarding patients for cooperation is consistent with good medical practice

    How can it be considered perfectly ethical to lock up a patient with psychosis and force them to take drugs against their wishes and yet be “unacceptable” and “unethical”1 to offer them money to take the same drugs to stay well? Claassen and colleagues offered five assertive outreach patients, with whom they had failed to establish effective maintenance medication, £5-£15 for each injection of depot antipsychotic.1 Four accepted the offer and have done well; three have stayed out of hospital for two years of follow-up and one improved so much he demanded a pay rise. It doesn't need a health economist to calculate that two years of such payment costs less than a day or two in hospital.

    Rewards and coercion already exist

    The intense opposition generated by Claassen's report of “money for medicines” should make us think about how we debate the moral problems of modern mental health care. It shows …

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